CCIIO explains what employee premium assistance notices you will and won’t receive in 2016

The Center for Consumer Information and Insurance Oversight (CCIIO) has provided some pointers for employers regarding the employer notice program for employees’ advance premium tax credits (APTCs) in new Frequently Asked Questions. The Patient Protection and Affordable Care Act (P.L. 111-148) and its implementing regulations, including HHS final Reg. Sec. 155.310(h), require the exchanges to notify employers if they have at least one employee who was determined to be eligible for an advance premium tax credit (APTC) and cost sharing reductions (CSRs), based on the employee’s assertion that he or she was neither enrolled in nor eligible for employer sponsored coverage that is affordable and meets the minimum value standard. Applicable large employers who fail to offer affordable, minimum essential coverage to employees and who have at least one employee who receives an APTC run afoul of the employer mandate provisions of ACA Sec. 1513, and are subject to heavy fines.

The CCIIO advises that, for the 2016 plan year, the federally-facilitated marketplaces (FFMs) and state-based marketplaces (SBMs) using the federal healthcare.gov platform will only send APTC notices to the employer address provided by the employee on his or her application for Marketplace coverage, so it is possible that some employer notices will not reach their intended recipients. As the FFM and SBMs continue implementation of the employer notice program, they will consider alternative ways of contacting employers, according to the CCIIO.

Once an employer receives such a notice from an exchange, it will have 90 days in which to appeal. Subsequent assessable payment notices from the IRS will indicate how much is owed.

No exchange notices for 2015 plan year. Employers should be aware, however, that in the spring of 2016, the first notices they receive, if any, will be from the IRS, not from the exchanges. Assessable payment liability notices from the IRS will, at that time, indicate that at least one of an employer’s employees received an advance premium tax credit in 2015.

Therefore, employers will not be getting a heads-up in the coming year with regard to whether or not they could be subject to penalties because one of their employees received an APTC. It is unclear as we go to press whether or not the 90-day appeals window provided by the exchanges will be the same length of time provided by the IRS for an appeal of its findings.

The CCIIO has stated that the employer notice program is being “phased in,” in order to improve efficiency and minimize confusion. In addition, only “certain” employers will receive notices in 2016 about APTCs, the CCIIO says, and the program will expand to include more employers in subsequent years. Also for 2016, employers will not receive notification if an employee benefiting from either an APTC or CSR terminates his or her coverage through an exchange.

Therefore, notices from the exchanges will only address the APTC for the 2016 plan year and beyond, and the IRS anticipated, in its “Questions and Answers on Employer Shared Responsibility Provisions Under the Affordable Care Act,“ updated May 20, 2015, that “contact for a given calendar year will not occur until after employees’ individual tax returns are due for that year claiming premium tax credits and after the due date for applicable large employers to file the information returns identifying their full-time employees and describing the coverage that was offered (if any).”

How to appeal. Within 90 days from the date of receiving a notice from the FFM, an employer who wishes to appeal must fill out an appeal request form, available on www.healthcare.gov/marketplace-appeals/. Appeals forms should be mailed to Health Insurance Marketplace, 465 Industrial Blvd., London, KY 40750, or faxed to 1-877-369-0129.